Questions about Applying to Epilepsy: Strategies, Virtual Interviews, Clinical Fellowship, Research Fellowship/Academia

[dennis-brodmann]

Hopefully this thread can help people going into epilepsy and considering academia.

CLINICAL FELLOWSHIP
I decided on applying to epilepsy - one of the clinical fellowships that has no match. Moreover, I am interested in surgical epilepsy/neurostimulation.

After talking to some people, I heard that every year, the cycle seems to start earlier and earlier. (After browsing at programs I am interested in, I think most opened in July and some opened up this month). I heard places offer positions on a rolling basis, with some offering you a spot even before you have interviewed with other programs.

1. How can you gracefully navigate these offers if you are unsure and want to hear from other programs?
2. If you have not heard from a program regarding an interview offer, what is the best way to prompt that program?
3. If there are programs that are not your top choices, should you wait to send your application later on rather than sending all applications at the same time?
   • I feel like the risk may be high in terms of losing a spot.

Regarding structure, websites list lots of numbers (e.g., 10 EMU beds, hundreds of epilepsy surgeries per year). I don't really know what to make of these metrics other than comparing my experiences during residency.

1. How many EMU beds, number of epilepsy surgeries (stereo EEG, device implantation, laser therapy), hardwired EEGs, ICU cvEEG, etc. can really make a difference?
   • Is there a minimum you all would recommend to be proficient?

VIRTUAL INTERVIEWS
I am assuming most interviews will be virtual this year.

1. In general, how should you approach these interviews?
2. Unless someone is walking with their camera phone, I doubt I would get to gauge the facilities. Does this matter?
3. What things should an applicant definitely ask to gauge if a program is a good fit?

RESEARCH DURING vs AFTER FELLOWSHIP
I want to remain in academia. I like teaching when I can and have goals regarding research. My background is in bioengineering, and outside of the recent hype with Neuralink, I have wanted to get involved with brain-machine interfacing as it relates to epilepsy (e.g., RNS, DBS). I really would like to be involved in the basic science/translational side of things rather than a purely clinical study. I don't have a PhD and am far-removed from any lab (e.g., wet or computational). I know 2-year epilepsy fellowships offer more research opportunities the second year, but I have also heard of learning to research after clinical fellowships.

1. For those of you who have gone through a 2-year clinical fellowship, what are the realities of doing research during this time?
   • I assume some of it has to do with the mission and culture of your fellowship, as well as funding.
   • What are the realities of having grants such as a T32 (e.g., How long does it take to get going with your project? What is the pressure like?)?
   • Can one learn how to write grants in this path?
   • If I needed to learn non-clinical, research techniques, would this be possible during this time?
2. Have any of you gone through a purely research fellowship after completing your clinical training?
   • Would any of your answers to my questions in #1 be different in this path?
   • My priority is the clinical training for epilepsy. If I ended up in a place that had the epilepsy training I wanted (e.g., surgical) but did not do the exact research that I want exposure to, would it be difficult to find a research fellowship or transition to an institution that did?
3. I understand that after a clinical fellowship, physicians can become an "instructor" and apply for a K-grant with guidance from a PhD.
   • What is the path like for those of you who have gone through it?

Thanks for bearing with another long post of mine! haha

D. Brod

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[Thama]

Not epilepsy but I did the pathway you are talking about in a different subspecialty.

Outside of neuro ICU, most 2 year clinical fellowships will have research time built in. If your fellowship is funded in part by a T32, then there will be a required amount of research time associated with that award which can differ depending on the program. Generally the T32 will protect most if not all your time for research.

It is far, far better to have research time integrated into the structure of a 2-3 year fellowship than it is to do 1 fully clinical year followed by a fully research year. Projects and mentorship take time to develop and you have much less chance of developing something that sticks in just a year. A program that expects to turn out clinician scientists but doesn't integrate that from early in fellowship I would consider a red flag. You ideally want to stick somewhere and start developing your niche from day 1 of fellowship.

If you are hired as faculty, have protected research time, and haven't secured funding yet, most of the time that will be at the instructor level. K-level funding is mentored and the mentor(s) should be experienced, independent research faculty at your institution, no matter the degrees they hold (MD, PhD, etc). These grants are designed to transition promising scientists to independence and get you ready to start submitting R grants. This funding is also quite competitive and plenty of people get stuck at this stage, don't land a K after several attempts, and then end up needing to take on mostly clinical duties.

 

[dennis-brodmann]

Not epilepsy but I did the pathway you are talking about in a different subspecialty.

Outside of neuro ICU, most 2 year clinical fellowships will have research time built in. If your fellowship is funded in part by a T32, then there will be a required amount of research time associated with that award which can differ depending on the program. Generally the T32 will protect most if not all your time for research.

It is far, far better to have research time integrated into the structure of a 2-3 year fellowship than it is to do 1 fully clinical year followed by a fully research year. Projects and mentorship take time to develop and you have much less chance of developing something that sticks in just a year. A program that expects to turn out clinician scientists but doesn't integrate that from early in fellowship I would consider a red flag. You ideally want to stick somewhere and start developing your niche from day 1 of fellowship.

If you are hired as faculty, have protected research time, and haven't secured funding yet, most of the time that will be at the instructor level. K-level funding is mentored and the mentor(s) should be experienced, independent research faculty at your institution, no matter the degrees they hold (MD, PhD, etc). These grants are designed to transition promising scientists to independence and get you ready to start submitting R grants. This funding is also quite competitive and plenty of people get stuck at this stage, don't land a K after several attempts, and then end up needing to take on mostly clinical duties.

Thank you, Thama! This is helpful!